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Novel migraine surgery gives patient new lease on life
By Dawn Brazell | News Center | January 10, 2014
|For the first time in years, Denise Stout is able to enjoy going outdoors in the sun and other activities thanks to a novel new treatment for migraine headaches.|
Denise Stout belts out the tune “Here Comes the Sun” as she twirls with uplifted hands in a shaft of sunlight in her backyard. Her teenage daughter, Savannah, stands spellbound.
“It’s so nice to see her not be depressed,” she said.
Gone are the big sunglasses her mother kept by her side and the dark heavy drapes over all the windows in the house. Instead of the frigid 62 degrees that required Savannah to wear two jackets at times, the house is a comfortable temperature. They finally can play music and go outside. They can own dogs again.
Stout stops to pet her new puppy. “It’s really freed me up to do things I haven’t done in a long time, like owning a dog,” she said of a recent innovative treatment for migraine headache that she underwent at MUSC.
“It’s a game changer. It’s a miracle,” she said, tears coming to her eyes. “I feel like singing. It’s beautiful. It’s so nice not to hurt.”
Stout has suffered from bad headaches since age 13 that intensified into migraine pain three years ago at 47. The pain was like an ice pick being driven into her head. At times it had her bedridden and rolling on the ground, begging for someone to please kill her. Twenty out of 30 days, the headaches plagued her. She would keep ice packs in the freezer and iron her head – literally – on top of a cloth to protect her hair.
“It helped. You do anything that will help.”
The chronic pain wore her down. She sank into depression. “When you suffer from chronic pain you lose your hope in life. All you can do is feel sorry for yourself and feel depressed. I used to call these suicide headaches because you wished you were dead you were in so much pain.”
Stout got referrals to all kinds of specialists, finally ending up in the office of Kevin Delaney, M.D., a plastic and reconstructive surgeon. It might seem an odd place to go for headaches, except Delaney heads up the new MUSC Advanced Migraine Surgery Program. His wife suffers from migraine headaches, so he has seen firsthand the toll it takes and researched the latest treatments available. His quest led him a few years ago to Cleveland plastic surgeon Bahman Guyuron, M.D., who is a pioneer of a surgical treatment for migraine headaches.
Guyuron noticed that some of his patients who had undergone cosmetic brow-lift surgery were more excited about the relief they experienced from their migraine headaches following cosmetic surgery. Research later showed that release of the supraorbital nerve, which is commonly done during brow-lift surgery, was the reason for this improvement. Since then researchers have discovered many other nerve “trigger” points that surgeons target to decompress in order to relieve migraine headache pain, similar to what’s done to treat carpal tunnel syndrome.
One way surgeons know if surgery will work for a chronic migraine headache sufferer is to try Botox treatments, something Stout underwent before her surgery. It was a procedure that made her nervous, not so much about enduring the injections at her suspected trigger sites, more so worrying about whether it would work. Stout, who had lost jobs and become very inactive, said she had watched her life dwindle down to very little. “It’s sad what you get used to.”
This was a last shot for her.
Fortunately, the Botox treatment worked. Stout knew the effects would wear off after a few months, but knew it offered hope that the surgical treatment would work for her. Delaney said studies have found the surgical procedure to be effective in more than 90 percent of cases. They have also shown that the procedure can result in the complete relief of migraine headaches in up to 50 percent of patients.
“It can be life changing. That’s why we’re so excited to be offering this at MUSC. Our goal here is to change lives for the better and there’s no better way to do that than to alleviate the migraine in patients who’ve been suffering for many years.”
Delaney said surgery offers another option for treatment since medications have side effects and fail to completely treat migraine headache pain for some patients. Migraine headaches are a significant problem in the nation, affecting about 35 million in the U.S. alone, which is about 13 percent of the population. The majority of people are females. It’s estimated that up to 30 percent of females will suffer from migraine headaches at some point in their life.
“It can affect their daily life. Many times the pain is debilitating, affecting the ability to keep a job and just function in daily life," he said, adding that the World Health Organization considers migraine headaches to be one of the top 20 debilitating conditions in the world.”
The migraine surgery treatment is an outpatient procedure done by plastic surgeons who are trained in a variety of specialties, including nerve surgery, microsurgery and cosmetic surgery. “It’s that unique skill set that makes plastic surgeons the physicians who are able to treat migraine headaches with surgery.”
The premise behind the surgery is that there are various nerves that are just under the skin in regions of the face, as well as the scalp and back of the head, and that these nerves are being pinched by overlying muscles, he said. As these nerves are being pinched, they trigger migraine headaches.
The MUSC Advanced Migraine Surgery Program takes a holistic approach. “We’re in a unique situation as a large academic medical center. We have the resources available to bring all different disciplines to a person with migraine headaches,” he said, referring to a long list of professionals, including neurologists, pain specialists, massage therapists, nutritionists and mental health specialists. Surgery may not be the best option. Physicians will recommend less invasive treatments to relieve pain as a first line of defense. However, if patients’ previous treatments and medications aren’t working and their migraine severity and duration aren’t being well controlled, then they should be evaluated to see if they are suitable for surgery, he said.
Stout was one of the first patients at MUSC to have the procedure in August of last year. They have since treated six more people and have 30 candidates considering the treatment. “Denise was having 15 to 20 headaches a month. She was at her wit’s end. She didn’t think there was any way she’d ever be without migraine headaches. She was referred to us out of desperation.”
Delaney was glad to see her respond well to the preliminary Botox treatment.
“She went from desperate and defeated prior to the Botox treatments to very excited and ecstatic about the possibility that she could go for the rest of her life without headaches.”
Delaney made well-concealed incisions to get access to the nerves that were being pinched by the muscles on the front of her head and back of her neck. Initially Stout had post-operative discomfort, but the nerves settled down as expected in about three months.
Stout said she can make plans and set goals now. She and her daughter want to start a vintage dress shop. “My brain works now,” she said, adding that it’s been more than a month since she’s had a headache. “I feel fantastic. I’m like a kid in a candy store."
For Delaney, it’s gratifying.
“She has a new lease on life and is able to go on and live her life in a much better way than she was with her migraine headaches. She has a new job and a new outlook. That’s what we want to do for all our patients that come see us. We want to provide them with a new lease on life.”